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Learning you have HIV, the virus that causes AIDS, can set off a flood of emotions — fear, anger, and sadness, to name a few. Those are normal reactions, but depression and other emotional problems need to be addressed — they can impact how well you fight the virus.

Mental illness and HIV have a strong link. First, rates of infection are higher among people who struggle with psychiatric disorders. The connection goes the other way, too. People with HIV are at greater risk of developing problems such as anxiety, drug and alcohol abuse, post-traumatic stress disorder (PTSD), and depression, says Carol Dawson-Rose, RN, PhD, a professor at the University of California at San Francisco School (UCSF) of Nursing who cares for people with HIV.

Depression in particular takes a heavy toll on people who are HIV-positive. They’re two to seven times more likely to have depression than those without the virus, according to research published in the journal Psychiatry and Clinical Neurosciences in 2014.

Why Are Stress and Depression Risks in HIV?

Mental illness is caused by a combination of family history and environmental, biological, and psychological-social factors, according to AIDS.gov, a website sponsored by the U.S. Department of Health and Human Services. With HIV, the social stigma of being infected and potential lack of social support feeds stress and depression, says Mallory Johnson, PhD, a UCSF professor and co-director of its Center for AIDS Prevention Studies.

Jeffrey L. Newman, an HIV-positive HIV/AIDS activist in New York City and blogger, says that shame and the fear of being ostracized or rejected, even by loved ones, are part of the problem. Newman adds that ignorance about HIV and AIDS is still an issue 35 years after the start of the epidemic. “Even now, when medications can keep people with HIV healthy and treat it as a chronic, manageable illness and not a death sentence, there are still people who aren’t informed and living with outdated information and fear.”

HIV management itself can also trigger stress, especially when first getting treatment, Dr. Johnson says. Medications need to be taken as directed every day for life. For some, just seeing the pill bottle every day is a reminder they have the virus and it brings up negative emotions, he adds.

Depression, Stress, and HIV: The Toll on Your Health

Long-term stress and untreated depression can weaken the immune system, Johnson says. That makes fighting the infection that much harder.

Depression can also affect how well you care for yourself. People who are depressed may resist beginning medication or stop using it, says William R. Short, MD, MPH, an HIV specialist and associate professor of clinical medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

People infected because of sexual abuse are at higher risk of never accepting treatment, Dr. Short adds. He says that two of his young patients who had been abused recently died after refusing to take the drugs.

Stress and depression can also lead to substance abuse. “For some, alcohol and drugs become a coping mechanism,” Newman says.

8 Tips to Relieve Stress and Manage Your Emotional Health

In addition to practicing healthy habits like eating well and getting enough sleep, these strategies can help you feel better physically and emotionally — which, in turn, can help you better manage HIV:

Confiding in someone. Keeping your HIV status a secret is stressful and socially isolating, Johnson says. Share your story with someone you know will be supportive, perhaps a person you know with HIV.

Joining a support group. The Internet offers a tremendous opportunity to bond with others living with HIV, Newman says. Facebook is especially good, he says, with many HIV pages to connect people and provide education. “I started an HIV group five years ago, for this exact purpose, called HIV and AIDS, Get The Facts, Curb The Ignorance, Prove It’s Getting Better,” Newman adds.

Meditating. Mindfulness-based meditation can lessen stress and depression in people with HIV, according to the Ontario HIV Treatment Network, in Canada. Meditation can help you learn to focus on the now, leave the past behind, and not worry about the future.

Learning a mantram. For this practice, you silently repeat a simple, uplifting phrase throughout the day, such as, “I choose to live,” or “Action conquers fear.” People with HIV who use mantrams feel less anger and more spiritually happy, according to AIDS.gov.

Exercising. Physical activity releases feel-good endorphins that can improve stress and depression, according to the Anxiety and Depression Association of America. Consider walking or biking for 30 minutes a day five times a week.

Practicing positive thinking. “I am a huge believer in the power of gratitude and positive thinking,” Newman says. “From day one of my diagnosis, I accepted that this was just a part of my story, but not my only story. I refuse to be defined by HIV or AIDS or allow negativity to control my life.”

In addition to taking steps to relieve stress and boost your emotional health, it’s important to recognize the signs of depression and seek professional health. If you’re experiencing sadness that won’t go away, losing interest in activities you once enjoyed, or experiencing other symptoms of depression, talk to your doctor. Therapy and medication can help.